Building on a pilot program begun in 2003, Illinois will implement "3-share" coverage in four counties this July to help small employers provide health insurance to their employees and dependents. The name refers to the fact that counties, employers, and employees will share the financing. This model was developed in Muskegon County, Michigan, and is being replicated in a number of communities across the nation.[1]
Program development began in St. Clair County with initial funding from a Health Resources and Services Administration State Planning Grant. In order to keep premiums affordable for all three parties, the benefit package is less comprehensive than those offered by most large employers. This also was designed to help guard against crowd-out, when small employers drop their coverage to take advantage of programs that require lower contributions from them. 3-share plans, which will be offered through the Pan American Life and Health Insurance company, covers physician office visits, emergency department visits, inpatient hospital, surgery, intensive care, skilled nursing facilities, mental disorder hospital stays, wellness care, lab and X-ray, prescription drugs, and discounted vision and dental care.
The premium structure is described below.
The state expects enrollment in the St. Clair program to begin at a modest level, with approximately 500 lives covered in the first year at a cost of $300,000 to each of the three contributing parties. They predict 1,000 covered lives after three years and 5,000 covered lives by the end of the fifth year, with costs rising accordingly to $3,000,000 per year per contributing sector.
In St. Clair, financing for the county share will come through a non-profit entity, the Illinois Health Access Plan for St. Clair County, which will receive funds from the county health department. The county health department has agreed to provide funds to the extent that they are being "freed up" from subsidizing the losses that public health clinics typically incur (largely from treating Medicaid patients at below cost). By certifying those clinic losses as "certified public expenditures" that are eligible for federal Medicaid matching funds, the clinics will receive additional Medicaid payments. This will enable the county to use their "freed up" dollars for the 3-share program. Work is still being done to finalize an agreement between the county and the state Medicaid agency on how the flow of funds will occur, so that "certified public expenditures," as envisioned, are acceptable to the federal government. This strategy is possible through a change in the Medicaid State Plan.
Many of the above design elements are also being applied in Macoupin (Carlinville) and Sangamon (Springfield) Counties, where waiting lists for 3-share programs have already begun to form.[2] In Winnebago (Rockford) County, the Rockford Health Access Plan began enrollment of a small test group in July 2003 and it is awaiting approval of the new financing mechanism to expand enrollment. Further, the state is seeking two additional counties in which to pilot the program: a metropolitan area with a large Latino population and a predominantly rural county.
References
[1] A Community Expands Access to Health Care: The Case of Access Health in Michigan. Fronstin P, Lee J., Health Affairs 24 (May/June 2005): 858–863.
[2] These counties are working with the state's Department of Insurance, based on their experiences as Community Access Program grantees, and enrollment is expected for July 2005.
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